Building a Campus for BMC's Future

In 2015, Boston Medical Center completed the first major project in our multi-year campus redesign with the opening of the Moakley Building addition. This year will be an even bigger year for construction at BMC, as multiple projects across campus will be finished or get underway by the end of 2016. The opening of each new space will improve resources, services, and overall experience for both patients and employees.

"Our clinical campus redesign is a huge undertaking that will serve as the foundation for BMC to continue as a health care leader for years to come," says Kate Walsh, President and CEO. "Our employees will have more modern, comfortable spaces to work and provide care, and when the redesign is finished, we will have the best facilities in Boston. This updated space is key to our commitment to be the best place in the city to work and receive care."

The first major opening of 2016 was the Women and Infants Center, which recently opened on the fourth floor of Yawkey. The new Center brings together the Ullian Neonatal Intensive Care Unit (NICU), Labor and Delivery, and all other hospital services for women from prenatal to postnatal care in a modern and comfortable setting for mothers and babies.

"This project required an enormous commitment of time, resources, and energy from colleagues across the hospital," says Nancy Gaden, DNP, RN, NEA-BC, Senior Vice President and Chief Nursing Officer. "We have created a beautiful new facility for our patients and families. Through this and other projects, we're bringing everyone at BMC, from clinicians to volunteers to support staff to patients, into the future. That's the best part of this."

The next big opening will be the new Yawkey cafeteria and Demonstration Kitchen at the end of March. The cafeteria will be a welcoming, inviting space for employees to gather, while the expanded Demonstration Kitchen will be able to provide its popular cooking classes to a wider audience. These openings will be followed by the opening of the new Food Pantry space in April. The current Food Pantry was built to serve 500 patients a month, but currently serves 7,000. The new space will accommodate the Food Pantry's space needs and greatly increase the number of patients they can serve.

After the Food Pantry opens, construction will continue through the summer, and the pedestrian bridge over Albany Street will be completed in early fall. By the end of the year, renovations in the Menino Building will be the primary focus and we anticipate that Radiology, the 3rd floor intensive care unit, and the Pediatric inpatient unit will move into their new spaces. Construction in Menino is expected to be complete in 2018.

"We strive to provide efficient, high-quality, and low-cost care for patients at BMC," says Ravin Davidoff, MD, Chief Medical Officer. "With the redesign, we have an incredible opportunity to build the type of space that will allow us to reach our goals and provide the right care to patients. BMC has always provided exceptional care, and our new space truly shows our commitment to getting it right for every patient who comes here."

While each new completed project and move brings benefits for staff, the most significant impact will come at the end of construction, when hospital operations and services are consolidated onto one campus. At that point, the hospital will realize substantial operational and financial gains through the efficiencies of a single campus. This will include $8 million per year in energy savings, and moving most of the energy loads of the hospital to solar and wind power.

"This is one of the most complicated health care projects ever seen, according to our construction partners, but we're on budget so far, which is unheard of in Boston hospitals," says Bob Biggio, Vice President of Facilities and Support Services. "We know the disruptions have been challenging, but staff have been very flexible and resilient. This helps make our complicated project easier. As we move forward with the renovation, employees shouldn't hesitate to reach out about any issues they or their patients are experiencing."

BMC Makes Progress in Combating C. Diff Infections

In 2016, Boston Medical Center is focusing on three major priorities to make BMC the best place to work and receive care: patient experience, growth, and quality of care. In the quality of care category, BMC is particularly focused on preventable harm and, specifically, reducing five types of hospital-acquired infections. BMC has been tackling one of these infections, Clostridium difficile (commonly known as C. diff), through the creation of a multidisciplinary task force, which brings together physicians, nurses, employees from Quality and Patient Safety, Housekeeping, and Transport. The task force started in July 2015 and unites isolated efforts against C. diff, a gastrointestinal infection, towards a common goal of bringing the ratio of observed/expected cases of C. diff to one or below.

"C. diff is a serious but preventable threat to our patients," said Cassandra Pierre, MD, MPH, associate hospital epidemiologist and infectious disease physician. "Improving patient outcomes - as well as anticipated Medicare financial penalties for hospital-acquired cases - gives us clear incentives to work together as a multidisciplinary team to reduce C. diff infections."

The task force is made up of four subgroups: antibiotic stewardship, ordering and testing, communications and cleaning, and hand hygiene. The antibiotic stewardship subgroup emphasizes appropriate antibiotic use to reduce C. diff infections. Some antibiotics, such as clindamycin, are associated with higher rates of C. diff. The group has worked to restrict the use of these C. diff-associated antibiotics by creating new protocols for ordering that require meeting certain requirements and pharmacist approval; the changes are in eMERGE and on the pharmacy website. So far, this effort has been successful in reducing the utilization of clindamycin across the hospital, and the group has even been able to move the target as utilization has been reduced.

The ordering and testing subgroup focuses on appropriate use of tests for C. diff. Inappropriate testing not only wastes hospital resources, but also increases the risk of false positives. To this end, the group has created a guide and instructions for ordering C. diff tests in eMERGE, which prompts physicians to answer a series of questions to determine if the test is appropriate. The new protocols also include links to more information about C. diff and appropriate testing, as well as suggestions for other conditions or infections to test for. The group has also worked with the lab so that they know when to reject samples, and has implemented education programs for the highest ordering groups. In the past few months, the number of tests for C. diff ordered within seven days of a negative test and repeat tests within 30 days of a positive result (neither of which are indicated by current standards) have dropped significantly, to under five per month for both. The overall volume of ordering for tests has also decreased significantly.

The communication and cleaning subgroup of the task force is working on contact plus precautions, which include special hand washing procedures and use of personal protective equipment. The subgroup has created new signage to communicate when a patient is on contact plus precautions for C. diff. The signs include instructions for cleaning the rooms on the back, and when the patient is discharged, the sign gets flipped to help ensure the rooms are cleaned properly. Rooms that have housed patients with C. diff must be cleaned with bleach and water using a special fogging machine called Sanosil. This new signage with the discharge cleaning instructions will be piloted on the ICUs in the near future. In addition, members of the task force have recently implemented daily rounding in which they look at the tests ordered within the last 24 hours and make sure that patients with a positive or unknown test result are in rooms with contact plus precautions and appropriate signage.

"C. diff is more difficult to get rid of than other bugs - we have to use a combination of bleach for daily disinfection and our Sanosil fogger after the patient has been discharged," says David Maffeo, Senior Director of Support Services. "While we've struggled with these practices in the past, our performance has markedly improved with new protocols and education. It takes a village to defeat C. diff. and we are all working hard on this issue."

The final subgroup of the task force is the hand hygiene subgroup. While appropriate hand hygiene is important for everyone throughout the hospital, it is particularly important in C. diff cases, where protocols call for washing thoroughly with soap and water, not just using hand sanitizer. This group is conducting audits, beginning in inpatient units and the Emergency Department, where they will observe hand hygiene and provide education. The goal is to have at least 95 percent compliance with hand hygiene procedures.

The task force has a number of next steps across all subgroups, in addition to continuing ongoing work. They are working to expand nursing education on what an appropriate sample looks like, which will include visual aids and HealthStream training. The group will also continue to work on optimizing testing volume by assessing reasons for over-ordering and addressing the issue of patients being on laxatives when tests are ordered. Eventually, when the testing volume is low enough, they hope that the test and precaution orders will be automatically bundled, and are currently exploring options for this. Bundling these steps will reduce the risk of infections spreading by putting more patients with suspected C. diff on precautions as soon as possible. Finally, the team is collecting data about antibiotic use and expanding educational materials about appropriate use.

BMC Shows Leadership at Quality Improvement Conference

Each year, more than 5,000 physicians, nurses, residents, medical students, and other health care stakeholders from across the country gather at the annual National Forum on Quality Improvement in Health Care. The conference, hosted by the Institute for Healthcare Improvement (IHI), provides an opportunity to learn from peers, exchange ideas, and share tools for quality improvement (QI) and patient safety. This year, Boston Medical Center had a large turnout at the conference, with 41 attendees, 26 of whom presented a poster or led a workshop.

"In previous years, we've had about four to six people at IHI, which is in line with other hospitals," says James Moses, MD, Medical Director of Quality Improvement and Associate Chief Quality Officer. "The fact that we had more than 40 attendees this year alone is especially impressive and demonstrates BMC's high level of engagement with and leadership in quality improvement and patient safety at the national level."

One group that has made quality improvement projects a priority at BMC is nurses, 12 of whom attended IHI; seven of the 12 presented at the conference.

"Nurses are often on the frontlines of patient care, so it was important to emphasize, as a department, the role that we play in improving quality for patients," says Nancy Gaden, DNP, RN, NEA-BC, Chief Nursing Officer. "I am proud to see how varied our QI projects are, from preventing falls to improving intake processes to reducing alarm fatigue. It shows that our nurses have truly recognized the importance of quality improvement across the hospital and take their role in that seriously."

Residents at BMC have also taken an active role in quality improvement initiatives across the hospital and had a strong presence at IHI. This year, sixteen BMC residents attended the conference, and of those, ten presented posters. In addition, Lakshman Swamy, an internal medicine resident, was one of four co-chairs of the conference, and along with Chris Worsham, another internal medicine resident from BMC, led IHI's Open School Student Congress.

The residents' presence was largely organized by BMC's Housestaff QI Council, which is made up of residents across disciplines who work together to improve quality at the hospital, and supported by the resident union, the Committee of Interns and Residents. In partnership with BMC's GME and Quality leadership, the Council plans and runs educational events, networking events, and events where residents can plan QI projects and learn from departments outside their own.

"Resident involvement in quality improvement is critical, because it's clear that you have to be on the ground to do quality improvement," says Swamy. "A lot of residents are actively interested in QI and want to make it part of their career, and the QI Council gives us the chance to take on real, tangible projects. BMC is also unique in the administrative support it provides for residents' involvement in these projects. And now, after IHI, residents are even more energized to keep their work going, since there was so much respect shown for what we're doing."

What do you do, Judy Burke?

What brought you to BMC?
I came to BMC (then City Hospital) as a student nurse, and I liked it enough to come back after I graduated. I worked on the medical/surgical floor, then in the adult ICU, and I've worked in the NICU for 26 years.

What do you do here?
In the NICU we take care of critically ill newborns. We facilitate the families' getting through this crisis period of their baby being in the NICU. We try to empower the family members and have them be active in the babies' care, even though it's an ICU. We try to make them feel like parents as much as they can, which helps them bond with their babies.

My tasks vary from day to day. We do primary care nursing, so you sign up with a baby when they're very young and small, and stay with that baby throughout their hospitalization. You come in and take care of that baby and help the family until the baby is discharged. Sometimes I'm in charge for the day, so I'll help out in high risk deliveries.

The NICU is moving to a new space soon. What will that mean for the department?
The biggest difference for patients will be privacy. Right now, we have one big, open room, but in the new space we'll have a lot of private rooms. Even the rooms that aren't private will only have four beds, so they'll have much more privacy for families. It will be quieter, and make things a little easier for families from an emotional standpoint. Sometimes, in this room, you can have a family with a very small, sick baby, and you just get them past that period, then another small, sick baby comes in. We put screens up, but the parents know and that can be very hard for them. In the new room, you can shield them from some of what goes on. Families will be able to have their own little area and feel more empowered in their space.

For employees, it's very exciting how nice the space is. Many of us were employees at City Hospital, so we went from that to here, and now we're going to the new space. This was nice, but the new space is just beautiful.

What's something about working in the NICU that people might not guess?
People might not guess how connected we become to the families. It's really nice to be able to have a relationship with the families. We had a reunion a few years ago, and the turnout was phenomenal. People really do feel like you're an extended part of their family and stay in contact.

Nurses tend to come to work in the NICU and stay here. I've been here for 32 years, and I'm in the middle of the pack. People don't often leave, because it's just such a treat to work with these families.

What do you like most about working at BMC?
The thing I like most is the patient population. BMC also gives nurses the opportunity to learn so much. When I first started working here, I was able to do so many different things right away. And I'm still learning.

What do you do for fun outside of work?
I have a dog and three grown children. I also love to travel.

Do you know a staff member who should be profiled? Send your suggestions to [email protected].

New Year, New You!

The New Year brings resolutions for 2016, and for many that includes taking better care of ourselves. Whether you want to lose weight, exercise more often, or feel less stressed, BMC offers a variety of programs, benefits, and discounts to help you achieve your goals.

Eat right

The Nutrition Resource Center provides a series of healthy cooking classes for BMC patients and employees. Participants learn how to make healthy meals and snacks, such as soups and stews, delicious vegetarian options, and healthier desserts. All classes are held in the Demonstration Kitchen in the Dowling building. To view the class schedule and reserve a spot, visit the website or call Tracy Burg, Registered Dietitian and Chef, at 414-3840.

Interested in losing weight? Weight Watchers can help you form good habits, eat smarter, and get more exercise, without making any food off-limits. Group meetings will help you stay accountable and allow you to share your experience while you achieve your weight loss goals. The group meets monthly on site and some insurance plans will refund part of the cost. New members are welcome. Contact Tanya Crews or Jenay Nasif for more information.

Eat right tip: Many people think of cutting out foods when they think of dieting - low sugar, low carb, low fat, and others are common. But eating in moderation is the easiest way to eat healthy and maintain a healthy weight. If you eat recommended portion sizes, it's easier to eat the foods you enjoy without depriving yourself. For example, a serving of meat is about the size of a deck of cards and a serving of pasta is about half a cup.

Get fit

With more than 30 locations in the Boston area, Boston Sports Club offers a wide array of classes and the latest equipment at a discounted membership rate of $49.95 per month, with no joining fee. There is an additional annual fee of $49.95. If the BMC employee is a member, family members may also be added on for the same discounted rates. For more details, call 800-611-9833, option 2.

The BURN Fitness Studio in the South End offers specialized group exercise classes, including indoor cycling and rowing, yoga, boot camp, and personal training. BMC employees can receive a 20 percent discount on memberships and class packs. To take advantage of this offer, email [email protected] from your BMC email address.

The four HealthWorks Fitness Centers in the Boston area offer fitness equipment, personal training, group classes, and spa services specifically for women. BMC employees receive a $10 discount on the monthly membership rate. New members also receive two complimentary personal fitness sessions, two small group training sessions, and a 25 minute massage. To learn more, contact Erica Evans at [email protected] or 617-859-7700.

South End Fitness Center, a fitness and wellness center located two blocks from the BMC campus, offers a discounted rate of $310 for a year-long membership when employees show their BMC ID badge at time of sign up.

Fitness Together, which provides personal training and nutrition services, offers a 15 percent discount on all training programs and nutritional counseling to BMC employees at their Cambridge location. Email [email protected] or call 617-547-4244 to register.

Weymouth Club, which features a pool, tennis courts, personal training, group fitness classes, and spa services, offers a 10 percent discount on membership to BMC employees. Call Membership Services at 781-337-4600 or visit their website for more information.

BMC employees are eligible for a 10 percent discount off memberships at the Greater Boston YMCA. Membership includes unlimited use of fitness and aquatic centers, free group exercise classes, two free sessions of Get Started coaching, free babysitting during workouts, reduced rates on youth and adult programs, personal training, and the use of most YMCAs in New England. Existing Y members are welcome to receive the monthly discount. Just bring proof of employment to the welcome center desk of the branch you originally joined. Visit your local YMCA in person with a government ID and your BMC ID badge to sign up and receive the discount.

Get fit tip: Do you unwind by watching your favorite shows? Turn TV time into fitness time! Use commercial breaks to do a few minutes at a time of exercises such as squats, crunches, or running in place.

Be well

The BMC Wellness Program is a resource for all employees at BMC. Wellness has many facets, including physical, mental, emotional, spiritual, religious, and social. This website provides information on existing programs such as the Employee Assistance Program (EAP) and ways to cope with stress, fatigue, and issues like depression and death.

Taking care of others can make it harder to take care of yourself. BMC employees can get help with services from Care.com, which provides a listing of pre-screened high quality caregivers for a variety of child, adult, pet and household services. To learn more call 855-781-1303 or visit bmc.care.com.

Effective time management can help you find the time to be well. Circles can help you manage your time and take care of your to-do list. Circles will research and provide information on anything you need, from finding an electrician to planning a vacation to joining a gm.

Quitting smoking is hard and people may need multiple attempts to be successful. BMC offers a variety of programs to employees with no out-of-pocket costs, including the Tobacco Treatment Center, the BMC Quit Smoking Program, and wellness coaching by phone.

Looking to improve your sleep? BMC has partnered with Sleepio to make their sleep improvement program available to employees. Take a two-minute test to discover your sleep score and how to improve it at Sleepio.

Be well tip: Most tasks or projects can be broken down into smaller components. Completing these components one at a time will make tasks more manageable and help you stay on track to check items off your to-do list.

Relax and rejuvinate

Acupuncture is available for employees on Monday evenings from 4:30-8 p.m. in the Family Medicine Clinic. Appointments last approximately one hour and the cost is between $25-40. Once a staff member starts acupuncture treatment, recurring appointments are guaranteed every other week at the same time for eight weeks. Contact Joanne Daley at [email protected] or 414-6228 to schedule an appointment.

Yoga is a gentle exercise that combines different postures/stretches with meditation and breathing exercises. It can help health conditions such as back pain, as well as relieve stress and anxiety. All BMC patients and employees are eligible to attend free yoga classes on Tuesdays from 6-7:15 p.m. and Thursdays from 4:30-6 p.m. in the lower level of the Moakley Building. Classes are suitable for all levels and no registration is required.

Qigong/tai chi is a Chinese practice that utilizes slow, graceful movements and breathing exercises to promote the circulation of "qi," or life force, within the body. It can increase balance and flexibility, as well as reduce stress and improve overall well-being. All BMC patients and employees are eligible to attend free tai chi classes on Wednesdays from 4-5:30 p.m. in the lower level of the Moakley building. Classes are suitable for all levels and no registration is required.

Massages are available to employees through the Family Medicine Department. An hour long session is $50, with sessions available on Wednesdays and Thursdays. Contact at Joanne Daley [email protected] or 414-6228 to schedule an appointment.

Relax and rejuvenate tip: Research shows that laughing can help you feel less stressed and more relaxed, and even lower blood pressure. Need a pick-me-up? Try a funny YouTube video or ask someone to tell you a joke.

News of Note

Greater Roslindale Medical and Dental Center Recognized as a Level 2 Medical Home
Greater Roslindale Medical and Dental Center, a BMC-affiliated community health center, was recognized as a Level 2 Medical Home by the National Committee for Quality Assurance. Recognition is based on six standards: patient-centered access, team-based care, population health management, care management and support, care coordination and care transitions, and performance management and quality improvement. This designation recognizes the Greater Roslindale Medical and Dental Center's commitment to patient-centered coordinated care.

Introducing the BMC Portfolio Program
The American Board of Medical Specialties (ABMS) has recognized BMC as one of 62 organizations nationwide eligible to participate in the Multi-Specialty Portfolio Program. The new BMC Portfolio Program is another step BMC is taking to achieve our mission of improving the health outcomes of the underserved. This will not only help our patients, but will award physicians Maintenance of Certification (MOC) credit by participating in the QI work performed at the hospital every day. Through the Portfolio Program, BMC is able to approve QI projects for MOC Part IV Credit, which applies to the 21 out of 24 specialty boards participating in the ABMS program. Read more about the program.

Awards and Accolades

Colleen LaBelle, BSN, RN-BC, CARN, Wins Excellence in Nursing Award
Colleen LaBelle, BSN, RN-BC, CARN, Nurse Manager of the BMC Office-Based Addiction Treatment (OBAT) program, was chosen as the inaugural winner of the Lillian Carter Exemplary Acts in Nursing Award from Modern Healthcare. The award recognizes a nurse or nursing program that is meeting a critical need in a community and is part of Modern Healthcare's first-ever Excellence in Nursing Program. LaBelle also serves as Program Director of Training and Technical Support for Massachusetts' OBAT program and a member of Governor Baker's Opioid Addiction Working Group.

Connie Packard, CHPA, Named President of IAHSS Foundation
Connie Packard, CHPA, Executive Director of Support Services at BMC, has been named President of the Board of Directors of the International Association for Healthcare Security and Safety Foundation (IAHSS). The IAHSS Foundation fosters and promotes the welfare of the public through educational and scientific research and helps to develop a healthcare security and safety body of knowledge.

Traci Green, PhD, Named to CDC Opioid Guideline Workgroup
Traci Green, PhD, Deputy Director of the Injury Prevention Center, has been named to the Centers for Disease Control's special working group to review and advise on guidelines for opioid prescribing.